Terms You Should Know to Understand USA Insurance
Terms You Should Know to Understand USA Insurance

Terms You Should Know to Understand USA Insurance

Allowed Amount

 In medical services covered by insurance, the amount covered by insurance benefit calculation. Sometimes called Eligible Expense, Payment Allowance, Negotiated Rate. If your healthcare organization charges you for more than the Allowed Amount, the difference may have to be paid by the insured.

Balance Billing

 It is called Balance Billing that the medical institution charges the difference between the amount of money for the medical service and the Allowed Amount that the insurance company targets for the benefit payment. If you are a homecare agency or provider of home healthcare services you should definately buy a good software with complete billing syste. myEZcare is a such healthcare software provider which helps you in complete claims processing with its advanced billing feature.

Co-Insurance (Insurance ratio)

In medical services covered by insurance, the percentage of medical expenses paid by the insured person for the Allowed Amount subject to insurance benefit reimbursement. When Deductible is set, both Co-Insurance and Deductible are self-paying. 


 When receiving medical services covered by insurance, Co refers to the fixed amount paid to medical institutions (eg, $ 15 per hospital visit), and Co to the percentage of medical expenses paid by insurance subscribers. -It is different from Insurance. The amount may vary depending on the type of medical service, such as the clinic or hospital.


 The amount that the insurer pays before the insurance company starts claim payments. For example, if Deductible is $ 2,000, the medical services covered by Deductible cannot receive insurance payments unless they pay all for up to $ 2,000. Not all medical services, such as some preventive medical services, are eligible for Deductible.

Of–Out Pocket-Maximum 

The maximum amount of medical expenses paid to be covered by insurance. In principle, the insurance company pays 100% of “Allowed Amount” for the payment of medical expenses exceeding the upper limit. It is required that payments for medical services must be included in the calculation of Out-of-Pocket Maximum. In addition, payments for medical services other than Balance Billing and Essential Health Benefits when using medical institutions outside of premiums and networks need not be included in the calculation of Out-of-Pocket Maximum.

UCR (Usual, Customary and Reasonable)

UCR is generally used to set Allowed Amount when using a medical institution outside the network. The standard amount of medical expenses set for each area based on the amount that the same or similar medical services are generally charged within the same area. 

Medical Insurance available in the USA
Types of Insurance in the USA and medical circumstances

Health Insurance and Medical Circumstances in the United States

The public health insurance system is a very different in the United States. In in the USA, only eligible persons can join the public medical insurance system. The main public health insurance programs are Medicare and Medicaid. Medicare is a federal government-managed system for people over the age of 65, people with disabilities, and people with severe kidney problems that require dialysis and transplantation. The target is operated by the state government and the federal government. Therefore, those who are not covered by these programs need to consider private insurance coverage. 

  • Indemnity

 In general, in the case of Indemnity, medical institutions are free to choose, and they can call a specialist without referrals. In some cases, the doctor may claim the medical expenses directly to the insurance company, and the insurance benefits may be obtained from the insurance company, and then the insurance claimant may be asked for the difference. You may have to claim insurance benefits.

  • PPO (Preferred Provider Organization)

 PPO is a network formed by an insurance company contracting with a medical institution such as a hospital or a doctor. In the case of using a medical institution in the network, a discounted rate pre-arranged for payment of medical expenses is applied. Although the use of medical institutions outside the network is also possible, the burden on the insured person is usually greater than the use of medical institutions in the network. PPO is currently the mainstream in medical insurance for employees, and although there are regional differences, about 50% use PPO.

  • HMO (Health Maintenance Organization)

 The insured person designates a primary care physician (Primary Care Physician) who is a member of the HMO network, and the medical care practitioner instructs the appropriate medical care. Generally, insurance is not applied when using a medical institution outside the network except in an emergency.

  • POS (Point of Service)

 It is an intermediate plan of PPO and HMO. In general, the point that you have to specify the attending physician is similar to HMO. Generally, within the network, it is possible to use other medical institutions without the referral of the attending physician. When using a medical institution outside the network, referral from the attending physician may be necessary, and the burden on the insured person may be greater than that of the medical institution in the network.

  • HDHP (High Deductible Health Plan)

A plan with a higher self-paying amount (disclaimer) compared to the conventional insurance plan, which allows for tax-free contribution / funding for the purpose of paying medical expenses such as Health Reimbursement Arrangement (HRA) and Health Savings Account (HSA). Can be used in conjunction with a medical accumulated account. 

 Dental Insurance

The treatment contents into three kinds of preventive treatment, basic treatment and expensive treatment, and apply different Co-Insurance to create a plan. 

Vision Correction Insurance

Vision correction insurance, as the name implies, is a test for correction of vision and insurance for eyeglasses. Treatment for eye diseases and injuries is covered by medical insurance. 


Why Cloud-Based Home Care Software is Necessary for Homecare Agencies
Why Cloud-Based Home Care Software is Necessary for Homecare Agencies

Why Cloud-Based Home Care Software is Necessary for Homecare Agencies

Introduction to Home Care

Have you ever heard the word home health care? This is a medical practice performed by a doctor visiting a patient’s home. That is, home care provides medical care at home for patients whose physical function is impaired, and it is difficult to go to the hospital. And home care is at the other end of “cure medicine” that uses advanced technology. In other words, when the bedridden old man or the disabled person who suffers from a sequela who cannot recover cannot go to the hospital but wants to receive continuous medical care at home, home care realizes it. Also, in the case of patients with cancer that are difficult to cure, many would like to return to a familiar home. At that time, home health care realizes the continuation of treatment at home.

Why You Need Home Care Software

Cloud means “cloud”, but when it is connected to a computer service, it is a mechanism to save information (data) on the Internet, not to a personal computer or mobile terminal that you use, etc. The data is not only at home but also at the office, school, library, internet cafe, etc., you can check the data using a PC or mobile terminal, edit it, upload it to the internet again It refers to a convenient mechanism that can be done. 

Cloud-type homecare software also exists in the Healthcare industry. Home Care software is used by healthcare agencies providing homecare services. In the home care software using the cloud, records of patient care and services rendered are stored on the Internet.

 There are great benefits of healthcare software and saves healthcare agencies from many issues and challenges. By opting for healthcare software, agencies can control expenditures, strict government regulations along with improving healthcare software.

Today, (Wi-Fi) environment is built, and it is more convenient when using portable input terminals such as laptop computers and tablet mobile terminals. In addition, some home care software companies may have a function to customize, for example, the menu and the contents of recreation among the items to be displayed on the tablet terminal according to the service of the nursing care provider. Usability in the field will be further improved.

Healthcare technology company myEZcare is one of the most preferred homecare software providers in the US. The company is proving most advanced home care software with advanced features. The features include scheduling, reporting, messaging, transportation, billing, employee management, patient management, EVV.

Soon home health care will spread throughout the country, and we hope that people who can stay at home with current technology will be able to stay at home where they are accustomed, and myEZcare is looking forward playing a significant role to improve and organize healthcare services provided at home.

Why Home Care is necessary

It is natural for humans to age and take care of others and to treat the world. Creating a society where caring for people is the last contribution to the family and society is the task that is now being sought and the efforts of the working generation.


Home Care Benefits & Why We Need HomeCare
Home Care Benefits & Why We Need HomeCare

Why We Need Home Care and Importance of Homecare in the US

What is Home Care

Home care is medical care that you do at home without being admitted to the hospital. This is done for patients who have difficulty coming to the hospital or when it is desirable to have medical treatment at home. However, in a broad sense, all medical practices conducted outside the hospital are also referred to as homecare, and this includes medical care at nursing homes.

Why do we need homecare?

Majority of people want medical treatment at home, and they want to live their own life with peace of There is a flow that raises the need for homecare by aiming at a society where you can realize your own life with peace of mind while receiving necessary medical and nursing care services in the area where you are used.

Homecare itself has been common but is expected to increase in the future. In the future, there will be fewer places that can receive medical care and fewer doctors who can provide medical services, so homecare will be essential to continue medical care.

When treatment is at its end, and the patient becomes aware of the end, they will want to spend the rest of their time at a familiar home rather than at the hospital. As a result, home health care allows patients to spend the rest of their time where they want it, and leads to the creation of opportunities for proactive treatment.

By taking care at home rather than at the hospital, you will be able to increase your time with your family. With home care, you can realize your family’s desire to have time together and, like a hospital, you can spend time with patients without worrying about time.

With the declining birthrate and the aging population, the problems of medical institutions and human resources are becoming more serious every year. If the declining birthrate and aging population continue at this pace, it will be necessary to set up a homecare system as medical institutions alone can not cope with patients.

Benefits of Home Care

The benefit of homecare is that patients and their families can be treated as they would in normal life by treating them in a familiar environment. If you look only at the treatment environment, the hospital will be better than at home, but you will feel distracted by staying in the hospital, so there is a merit that you can work in a positive attitude towards treatment by treating at home.